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Developed in the late 1980s, Dialectical Therapy or Dialectical Behavior Therapy is a type of cognitive-behavioral psychotherapy that has been especially effective in treating those individuals with borderline personality disorder. In addition, it has more recently been adapted to also assist individuals with other kinds of self-destructive behaviors, including self-harm, eating disorders or substance abuse, and may also be successful in addressing the issues associated with Post-traumatic Stress Disorder.

Dr. Marsha Linehan, the creator of Dialectical Behavior Therapy (DBT), was prompted to develop this therapy, along with several colleagues, in order to enhance the cognitive behavioral therapy that was being used with individuals with borderline personality disorder (BPD). They found that more was needed to help these individuals and, as such, they were prompted to make changes and add  techniques that they felt would better benefit these individuals.

What is dialectics?

Mention the word “dialectics” and most will go to the root word “dialect” and assume that this term has something to do with languages and the way different people speak. But the two words aren’t really connected at all.

The term “dialectics” refers to the theory that everything is composed of opposites and that change can occur when one opposing force is stronger than the other. Dialectics hinges on three different assumptions:

  • All things are interconnected
  • Change will inevitably happen and is constant
  • Opposites can come together to form a closer approximation of the truth

Based on these three assumptions, the patient and the therapist work together to resolve the contradiction between self-acceptance and change. Success is demonstrated when the patient exhibits positive changes.

Linehan and her colleagues also stressed that validation should be an important part of this type of therapy. The therapist using DBT is encouraged to “validate” the patient’s actions by letting him/her know that his/her actions make sense given their situation, even if the actions aren’t ideal. Then, when change is suggested, the patient is more open to the push for this change because their actions and feelings have already been validated.

Dialectics and Borderline Personality Disorder

Psychologists have observed that individuals with BPD react more strongly and sometimes in unusual ways to certain emotional situations, especially romantic relationships and relationships with family and friends. They see the world as black-and-white, experience severe emotional swings, and appear to those around them to always be moving from one crisis situation to another.

DBT theory hypothesizes that the arousal levels for borderline personality disorder sufferers in such highly emotionally-charged situations can increase far more quickly than that of an average person and that they attain a higher level of emotional stimulation than most people. It also takes a significant amount of time for them to return to baseline arousal levels. Most will have no method of coping with these huge surges of emotion, so the goal of the DBT psychologist is to teach them skills that will help with this.

How does DBT work?

There are basically three components to dialectical therapy. Each is an important part of the process of addressing BPD and other mental health issues that have been deemed appropriate for treatment with this type of therapy.

  • Individual therapy – One-on-one sessions with a DBT-trained therapist will emphasize problem-solving behaviors for issues that arose during the past week or any personal life challenges the patient may be facing in general. These will happen once per week and will likely be 60 minutes-long. Any self-injury or suicidal behaviors will be addressed at individual sessions as will negative behaviors that can interfere with the process of psychotherapy. The counselor will also work to lessen post-traumatic stress responses and help the patient develop self-respect.
  • Group therapy – Led by a DBT-trained therapist, these group sessions usually last 120-180 minutes and will stress the following skills: interpersonal effectiveness, emotion regulation, distress tolerance/reality acceptance skills, and mindfulness. (See more information on these below.) Patients will be assigned homework and will participate in role-playing with the therapist and fellow participants.
  • Phone coaching – The patient can call their therapist (and is encouraged to do so) in between sessions so that they can address situations in “real time”, so to speak. A call will provide them with guidance as to how to handle a situation currently unfolding.

All three components work together to assist the patient in recognizing their positive strengths and attributes and to learn how to build on them, to help patients learn to recognize destructive behaviors and replace them with more productive behaviors, and to learn strategies that will help them accept and tolerate who they are and what their emotions bring to the table. All of this can help the patient make positive changes in their behavior which should also assist in improving their interactions with others.

The Four Modules of Dialectical Behavior Therapy

Four main strategies are used in DBT to help patients change their behavior and, as such, their lives:

  • Mindfulness – Mindfulness skills teach patients how to live in the moment rather than in the past or future. This helps patients better recognize what’s going on inside of them as well as outside of them. These skills help patients to slow down and stay calm and prompt them to avoid immediately reactions that include destructive behavior.
  • Distress tolerance – This technique teaches patients to survive a crisis using four steps: distraction, self-soothing, improving the movement, and thinking of pros and cons. This helps to address a variety of intense emotions.
  • Interpersonal effectiveness – This helps patients become more assertive in their personal relationships while also keeping those relationships positive. Communicating effectively and learning how to deal with difficult people is part of this module.
  • Emotion regulation – This module teaches patients how to adjust their emotions for a particular situation and how to react to negative emotions in order to reduce their vulnerability.


Dialectical Behavior Therapy is the psychotherapy of choice for many individuals suffering from a variety of mental health issues. If you think DBT can help you or someone you love, call our office for more information or to speak to one of our therapists.